Provider Demographics
NPI:1073547238
Name:GANSCHOW, SUZANNE MARIE (LPC, CAADC, BC-TMH)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:GANSCHOW
Suffix:
Gender:F
Credentials:LPC, CAADC, BC-TMH
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:GANSCHOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, CAADC, BC-TMH
Mailing Address - Street 1:2112 BIENVILLE BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3067
Mailing Address - Country:US
Mailing Address - Phone:228-819-2171
Mailing Address - Fax:228-205-4986
Practice Address - Street 1:2112 BIENVILLE BLVD STE K
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3067
Practice Address - Country:US
Practice Address - Phone:228-819-2171
Practice Address - Fax:228-205-4986
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1053101YA0400X, 101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05822714Medicaid